Health Net Healthy Heart (HMO) By Health Net of California

Health Net Healthy Heart (HMO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Health Net of California. This plan from Health Net of California works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Health Net Healthy Heart (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Health Net of California and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Coverage Area for Health Net Healthy Heart (HMO)

COMPARE AND SAVE ON MEDICARE INSURANCE

The Health Net Healthy Heart (HMO) H0562-100 is available to residents in California, and has a in-network Maximum Out-of-Pocket limit of $3,400 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Health Net Healthy Heart (HMO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $3,400 This is a very nice safety net. This plan includesadditional Medicare prescription drug (Part-D) coverage.

Health Net Healthy Heart (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Ratings for Health Net Healthy Heart (HMO) H0562

2014 Overall Rating

Part C Summary Rating

Total Experience Rating

Complaints, Improvements

Total Customer Service Rating

Total Preventative Rating

Chronic And Long Term Care

Member Experience Rating for Health Net Healthy Heart (HMO)

Total Experience Rating

Getting Needed Care

Timely Care and Appointments

Customer Service

Health Care Quality

Rating of Health Plan

Care Coordination

Member Complaints, Problems Getting Service and Improvements in Health Plans

Total Rating

Members Leaving the Plan

Complaints about Health Plan

Access to Service

Performance Problems

Health Plan Quality Improvement

Customer Service Rating for Health Net Healthy Heart (HMO)

Total Customer Service Rating

Timely Decisions About Appeals

Reviewing Appeals Decisions

Call Center

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating

Breast Cancer Screening

Colorectal Cancel Screening

Cardiovascular Screening

Diabetes Care

Glaucoma Testing

Annual Flu Vaccine

Improving Physical

Improving Mental Health

Monitoring Physical Activity

Adult BMI Assessment

Ratings For Managing Chronic And Long Term Care

Total Rating

Medication Review

Functional Status Assessment

Pain Screening

Osteoporosis Management

Diabetes Care - Eye Exam

Diabetes Care - Kidney Disease

Diabetes Care - Blood Sugar

Diabetes Care - Cholesterol

Controlling Blood Pressure

Rheumatoid Arthritis

Improving Bladder Control

Reducing Risk of Falling

Plan - Cause Readmissions

Part-C Premium

Health Net of California plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

The Health Net Healthy Heart (HMO) plan has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Health Net of California plan offers a $0.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Health Net of California above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Health Net Healthy Heart (HMO) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.

Part C Premium:

$0.00

Part D (Drug) Premium:

$0.00

Part D Supplemental Premium

$0.00

Total Part D Premium:

$0.00

Drug Deductible:

$0.00

Tiers with No Deductible:

0

Benchmark:

not below the regional benchmark

Type of Medicare Health Plan:

Enhanced Alternative

Drug Benefit Type:

Enhanced

Full LIS Premium:

$0.00

75% LIS Premium:

$0.00

50% LIS Premium:

$0.00

25% LIS Premium:

$0.00

Inital Coverage Limit:

$2850

Gap Coverage:

Many Generics, Few Brands

Gap Coverage

In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Health Net of California plan offers Many Generics, Few Brands through the gap.
Many means 65% to 100% of the formulary drugs are covered if you are in the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.